Self-prescribing declining among young doctors

NEW YORK (Reuters Health) - Far fewer doctors-in-training are prescribing themselves medication than in the past, suggests a new study.

Less than one percent of residents surveyed said they wrote themselves a prescription for an allergy medication, antidepressant or another drug over the course of a year.

In a similar study from more than a decade ago, over half of all medical trainees reported self-prescribing, which many consider ethically questionable.

"I would say it looks like, taking (the findings) at face value, that young residents and physicians-in-training are following recommendations about ethical considerations about treating themselves, and that seems like a good thing," said Dr. Ajit Limaye, from the University of Washington in Seattle.

Still, Limaye -- who has studied physician self-prescribing but wasn't involved in the new study -- cautioned against drawing too much confidence from its results.

"The practice, anecdotally from my experience, is very common," he told Reuters Health.

While it's not illegal for doctors to self-prescribe most types of medication (with the exception of controlled substances), researchers as well as the American Medical Association generally consider it a bad idea.

For one, doctors aren't the most objective prescribers when they're treating themselves. Another concern is that residents and other doctors may self-prescribe using free samples from pharmaceutical companies, which could bias the drugs they recommend to patients in the future.

In one study from 1998 co-authored by Dr. David Asch at the University of Pennsylvania in Philadelphia, 52 percent of young doctors reported self-prescribing during their training.

To see whether that's changed over time, Dr. Constance Guille from the Medical University of South Carolina in Charleston and Dr. Srijan Sen from the University of Michigan in Ann Arbor surveyed residents at 16 United States medical centers during the 2009 to 2010 and 2010 to 2011 academic years.

The researchers followed about 1,600 of the doctors-in-training during their year-long residency with online surveys about medication use every few months.

Just under 1,300 of the residents completed at least one survey. Of them, 140 -- or 11 percent -- said they used any prescription medication whatsoever during the year. Those most common included antidepressants, antibiotics and asthma and allergy drugs.

Most of the residents said they got the drugs from a personal doctor or a colleague, and only 11 reported writing the prescriptions themselves, Guille and Sen wrote in the Archives of Internal Medicine.

New restrictions that keep pharmaceutical company reps from interacting with doctors-in-training could at least partly explain the drop in self-prescribing, researchers said.

Guille suggested that another explanation could be limits on the number of hours residents can work each week that went into place in 2003, giving them more time to see their own doctor outside of work hours.

"The way to look at this is: is something we're doing with residents preventing them from getting the best care possible, and are they thus turning to self-prescribing?" Asch, who didn't participate in this research, told Reuters Health.

Of course, Limaye pointed out, the ethics of self-prescribing can depend on the situation. It's one thing to write yourself a refill for blood pressure medication you've been on for years when your doctor's unavailable, for example, and another to put yourself on anti-anxiety medication without consulting another physician.

Asch said he was surprised by the generally low number of participants in the survey who were on any prescription drug, and both he and Limaye wondered if some of the residents were hesitant to admit medications they were taking, including those they were prescribing themselves.

Still, one of the study's authors said the new findings could be seen as hopeful.

"I think it's pretty reassuring to know that these physicians-in-training are of the practice of prescribing medication based on their education and data," and not pharmaceutical company influence, Guille told Reuters Health.

"I hope that really continues to persist as they move out into practice as well."